Student Complaint Form

Background Information

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Student Complainant:

Person Submitting Complaint:

Telephone Number:

Email Address:

Email address must be of a valid format.

Report About:(Required):

This field is required.

Date of Incident(Required):

This field is required.

Time of Incident:

Location of Incident(Required):

This field is required.

Specific Location:

Involved Parties

Name or Organization

Select Role

Phone Number

Email Address

Hall/Address

Questions

Have you met with the employee to discuss the matter directly?(Required)

Yes No

You must make at least one selection.

Have you met with the supervisor of the involved employee?(Required)

Yes No

You must make at least one selection.

What is your concern or complaint? Please identify the reason for submitting the complaint and explain, in detail, all circumstances related to the complaint. All information pertaining to your complaint will be kept private and only shared with those needing to know.(Required) This field is required.

Has there been an attempt at an informal resolution? Please explain, in detail, all attempts at an informal resolution including a summary of the results of your informal resolution attempt(s) and identify the employees involved in these efforts.(Required) This field is required.

What would be your desired outcome with this matter and how would this resolve the reason for your complaint?(Required) This field is required.

What is the best way to reach you? Please be specific to allow for best service.(Required) This field is required.

I understand that referrals from this form will be reviewed during normal business hours (M-F, 8AM - 4 PM) and are not monitored after hours, on weekends, or during official University holidays.(Required)

Yes, I understand

You must make at least one selection.

Supporting Documentation of prior attempted resolution of this matter

Students should include all decision and appeal letters as well as all other documentation needed for further review of this matter. 5GB maximum total size.
Attachments require time to upload, so please be patient after submitting this form.

Email me a copy of this report

Background Information

Involved Parties

Questions

Supporting Documentation of prior attempted resolution of this matter

Submission